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Waverley Enrolment form FRONTpub

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Waverley Enrolment form FRONTpub Powered By Docstoc
					                        NOTHIN’ BUT NET
                          BASKETBALL
  Waverley Basketball Stadium                                            Cnr Power Ave & Batesford Rd. Chadstone

                    Wednesday 9th July 2008 — Thursday 10th July 2008
                                     9:00am—3:00pm
                                5—15 years—Boys & Girls

      Head Coaches Darryl “Dmac” McDonald & Matt Shanahan
                                  Only $60 - discounts available!!!!
                  $10 discount for additional enrolments from the same household
         $10 discount per player for Group Enrolments (4 players or more) - must be lodged
                                       together & paid in full
                                  ONLY ONE DISCOUNT PER ENTRY
         Each player receives a free Nothin’ but Net Basketball t-shirt
ENROLMENT FORMS MUST BE LODGED WITH NOTHIN’ BUT NET BASKETBALL PRIOR TO 8TH JULY

 PAYMENT OPTIONS                 WAVERLEY CAMP : 9TH—10TH JULY 2008 ENROLMENT
      CASH
                                Name: ________________________________________________________
Cash payments only can be       Address: ______________________________________________________
made on Day 1 of Camp—
Enrolments must be lodged       Suburb: _______________________                          Postcode: ______________
prior to camp commencing        Date of Birth: ____/____/____                            Age:___________________
                                Male/Female:______________
      CHEQUE
                                T-shirt size (circle) Childrens:         8       10      12       14
Cheques to be made payable
to Matthew Shanahan                                     Adults:          XS      S       M        L
                                Club: _____________________                      Grade: ______________________

     MONEY ORDER                Parent/Guardian Name: ___________________________________________
                            Phone: _________________      Email: ____________________________
Money orders to be made
payable to Matthew Shanahan Emergency Contact Name: ____________________ Phone: _____________
                                Please list any medical/health issues: ________________________________
Enrolment forms to be
                                ______________________________________________________________
returned to:
                                If necessary, I give permission for the person in charge to seek medical
Nothin’ but Net      attention: (circle)               YES             NO
Basketball           I HEARBY AUTHORISE THE STAFF OF NOTHIN’ BUT NET BASKETBALL TO ACT FOR ME ACCORDING TO THEIR
                     BEST JUDGEMENT IN ANY EMERGENCY REQUIRING MEDICAL ATTENTION, AND I HEARBY WAIVE AND
Matt Shanahan        RELEASE MATTHEW SHANAHAN & THE NOTHIN’ BUT NET BASKETBALL CAMP & STAFF FROM ANY LIABILITY
                     FOR ANY INJURY OR ILLNESS INCURRED WHILST AT THE CAMP. I HAVE NO KNOWLEDGE OR ANY PHYSICAL
PO Box 592           IMPAIRMENT THAT WOULD BE AFFECTED BY THE ABOVE NAMED PERSON PARTICIPATING IN THE NOTHIN’
                                                                                                         THE
Mt Waverley VIC 3149 BUT NET BASKETBALL CAMP. I ALSO UNDERSTAND THAT NOTHIN’ BUT NET BASKETBALL RETAINSAT THE
                     RIGHT TO USE FOR ANY PUBLICITY & ADVERTISING PURPOSES PHOTOGRAPHS OF PLAYERS TAKEN
                                CAMP, AND RESERVES THE RIGHT NOT TO REFUND ANY CAMP FEES DUE TO THE PARTICIPANT NOT
                                ATTENDING THE PROGRAM.
All enrolments must be
received prior to 9th July      Parent/Guardian: ____________________                 ________________          ________
2008.                                                    (Please print name)                  (Signature)         (Date)

				
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Description: Waverley Enrolment form FRONTpub